Resident work-hour regulations

.....The landscape of the orthopaedic workforce is changing. An aging population, rising obesity rates, greater lifestyle expectations, and technologic advances are increasing the demand for musculoskeletal services. At the same time, teaching institutions are under strain amidst resident work-hour regulations and the need to balance patient care and education. These goals collide in today's economic climate. As lawmakers, patient advocates, and academic centers consider implementation of further resident work-hour restrictions, the fiscal viability of these proposals remains unknown.

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) reduced resident duty hours to no more than eighty hours per week, averaged over a four-week period. The ACGME implemented these limits out of concern that resident fatigue endangered patients and the residents themselves. The regulations were rooted in the 2001 New York State mandate. A growing body of literature underscores the benefits and shortfalls of reduced resident work hours on patient safety resident morale, quality of life, and education and operative experience. One factor not often discussed is the financial impact of the reduced hours—to our knowledge, no study has evaluated the economic impact of reduced hours in orthopaedic resident education.

Early research on the duty limits shows resident fatigue is still a major problem. This prompted the Institute of Medicine in December 2008 to suggest further work-hour modification, while other discussions of resident work hours have included reductions to as low as fifty-six hours. Furthermore, some state legislators have discussed criminalizing duty-hour violators. Residents in other countries, such as the United Kingdom, Denmark, New Zealand, and France, work between thirty-seven and seventy-two hours per week. However, physician labor-supply shortages and insufficient training are a problem in these countries.

In light of these calls for additional duty limits, we examined the economic implications of a fifty-six-hour work-week regulation for orthopaedic training programs. Through the use of pilot-survey data, we undertook a cost-sensitivity analysis. Our hypothesis, based on workforce data after the eighty-hour work-week restrictions, was that the economic impact of furthered reduced hours, especially if not funded by the government, may make the orthopaedic resident workforce unsustainable...